Ignoring inadequate provider networks with 90% inaccuracies!
Complicit with state insurance regulators!
Prices more than doubled in three years, and will rise for three more years!
Instability, uncertainty, sabotage, destroying our healthcare on purpose!
Medicaid insurers taking over the individual market, at rip-off rates!
Healthcare ripped away from 22 million people, 850,000 Ohioans!
Block grants to criminal states with turkey insurance departments!
Eliminating Medicaid expansion and punishing the poor!
Over 50, put out to pasture!
Unethical! Uncivilized! Cruel!
215,000 of Ohio’s 715,000 adults receiving Medicaid through the ACA’s Medicaid expansion are being treated for opioid addiction!
The Ohio Department of Insurance’s director Mary Taylor made a public announcement this month that both her young sons have suffered from opioid addiction. But during all those years that her sons suffered from opioid addiction, she had allowed insurance to be sold with 90% inaccuracies, denying crucial healthcare to Ohioans who bought individual health insurance plans, who could have needed treatment for opioid addiction.
Ohio Senator Rob Portman lobbies for opioid addiction treatment, but ignores the crime of health insurance being sold with inadequate and 90% inaccurate provider networks, denying healthcare to those who buy it, including those who need opioid addiction treatment.
Medicaid block grants going to states, where fools like Mary Taylor, who is running for governor, would have complete control of the money and complete control of Ohioans’ access to healthcare, is dumb, dumb, dumb!
Kasich initiated an expansion of Medicaid, made possible by Obamacare, and has been accepting federal funds to serve an additional 715,000 low-income Ohioans, including roughly 215,000 with drug abuse and addiction issues.
“Right now, Obamacare, including Medicaid, is not sustainable,” Taylor said. “So, the ball is in the court of Washington now. They have to figure out what they’re going to do going forward with regard to any provisions related to Obamacare.”
Anthem is the only insurer right now in 19 Ohio counties, and in 2018 they will be exiting the Ohio individual market, except for one teeny tiny county, Pike, for a non-exchange plan that probably has 5 members, just so they can keep their foot in the door and not be banned for five years in case they want to come back. Awe.
Isn’t a market-driven health care system great.
Anthem has about 18% of the individual market in Ohio, and they insure millions of Ohio corporate and state workers. 40,000 individuals are presently covered by Anthem, and 10,000 people may not be offered any individual plan next year as a result.
In Toledo, Anthem has the worst, smallest provider network, and it was 66% inaccurate. It is highly expensive, and went up quite a bit last year.
Anthem more than tripled their premiums in seven years, just like Medical Mutual did, who removed themselves just this year from insuring an estimated 100,000 covered lives with their PPO plans, thus eliminating the only national network plan sold to individuals in Ohio. Last year two insurers covered nearly 50% of the Ohio individual market, and now they are gone.
Also gone this year is United Healthcare and Aetna, so just like that, our four largest insurers of the individual market are gone from the individual market, and Ohio let them, even rewarding the insurers with our state employee insurance business. Ohio either has no business sense, or our state really doesn’t care whether or not 300,000 Ohioans can buy insurance in the individual market.
Four things that Ohio can do to mitigate this healthcare crisis:
Ohio should do what New York is doing this year, and ban insurers who leave the exchange from any future participation in public programs such as Medicaid.
Ohio should propose a Medicaid buy-in for anyone in the state, like the plan that Nevada’s legislature just passed for it’s citizens. After all, our commercial insurers in the individual market (Anthem, Medical Mutual, United Healthcare, Aetna) have been replaced by Medicaid insurers (Buckeye Ambetter, CareSource, Molina), and since all of Ohio is covered for Medicaid, it makes sense that these insurers can also cover all of Ohio for the individual market, and with great ease.
Ohio should pass an emergency “any willing provider” law so that citizens can take their insurance dollars to any provider willing to accept them and the payment. At an average of 80% inaccuracies in our provider networks, have the worst that have been reported in the entire country! It’s only civilized that Ohio gives us an”any willing provider” law.
Oscar Insurance Corporation of Ohio, a new insurer for Ohio this year, should cover all the counties that Anthem has left hanging.
But they won’t be covering even one of them. It comes to Ohio to set up shop with Cleveland Clinic in the five counties around Cleveland.
It’s a perfect example to show why market-driven health insurance does not jive with societal needs, and it never will.
(Dream on, hoping for a private, for-profit insurance industry to voluntarily go into 19 counties for the business of a mere 10,000 people who won’t otherwise have insurance, when the company can get the same business by simply marketing to the east side of Cleveland. But for some reason, the for-profit, so called “free market” health insurance model persists. And it has nothing to do with what is best for our country.)
Here’s something the federal government can do: Open up the D.C. Exchange to people without an option, as per U.S. Senator Claire McCaskill’s proposal.
The D.C. Exchange sells insurance for everyone in the country, that is, everyone who is a member of Congress or their staff. I have researched the plans and found that they are really inexpensive compared to what is sold in Ohio. Moreover, it’s quality PPO insurance with national provider networks.
At one time, the ACA was going to have just one exchange for the entire country, like this exchange in D.C. But then the insurers got their mitts on the shaping of the ACA. They sliced it up into hundreds of different state and county plans. Four short years later, insurers are leaving, and hundreds of counties will have no insurance option. It seems logical to open up the D.C. exchange, for everyone. What would be wrong with doing that?
On a final note, the chart below shows the three largest insurers in Ohio, from a report made to the state of Ohio by the actuarial company, Milliman, in 2011. I added to the original chart in light blue, to show the individual rate increases since 2010. (The dark blue along with the red and green show the 2010 rates.)
With the withdrawal of Anthem, none will be in the individual market next year! Our three biggest insurers in the individual market in 2010, gone!
It’s no wonder, because our regulators let their rates go up over 300% in 7 years, while the rates for the group plans went up only a total of 30%. Wow. You’d think that all the new members of these plans had leprosy. I hope they are cured, at least.
Divide, divide, divide. Divide and subtract some more! The huge free market health insurance system is so close to knocking off those 23 million people who just don’t fit in their money-making calculations.
Click on the crowns to read about my representatives. I’m deeply disappointed that they won’t fix the problems that are completely in their control to fix right now, like the highly inaccurate provider networks, and the transparency that the ACA provided for that they won’t abide by, and that they won’t pass an emergency “any willing provider” law so I can take my insurance dollars to my own doctor, and I’m shocked that when they say they are going to give us something better than the ACA, that they only think of the insurance industry, still putting profits over people. King Moola rules. Please, mini Moolas, please please throw us some crumbs!
If you are going to let yourself be crowned by the lobbyists, at least understand the concept of noblesse oblige. It’s like this: the masters must be responsible for those they tame.
Enforcing [directory-accuracy rules] is “consumer-driven,” said David Hopcraft, a spokesman for the Ohio Insurance Department. The state does not check the lists until consumers report inaccuracies, one doctor at a time.
This is my great great grandfather’s photo of the Kickapoo Indian Medicine Company.
The Kickapoo Indian Medicine Company, of New Haven, Connecticut, sold “patent medicine” before they had patents for medicine. They sold snake oil when it was the cure-all. They weren’t really Indian. Kickapoo Medicine was often laced with alcohol, morphine, opium, or cocaine.
knowing that he’s a member of the “Freedom Caucus”
Congressmen are supposed to be concerned with the wellbeing of the people in the state to which they serve. But U.S. Representative Jim Jordan went out of his way to make uncaring comments on the report of Ohio’s highly inaccurate provider networks by Kaiser Health News and the New York Times, and how Ohio’s inaccuracies are the worst in the country, and that the state insurance department does nothing to fix the problem.(New York Times, December 4, 2016, Insurers’ Flawed Lists Send Patients Scrambling)
“It should surprise no one that the Ohio Department of Insurance’s physician directories are so flawed, considering how flawed the Affordable Care Act (ACA) is.”
“It’s sadly no surprise that the doctors’ lists were flawed as well,” Rep. James “Jim” Jordan (R-OH) said during a Patient Daily email interview. “Health care will be better and more affordable when Obamacare is gone.”
The Ohio Department of Insurance does not have physician directories, the insurance companies do, so Congressman Jim Jordan doesn’t know what he’s talking about. Yet he feels compelled to blame the ACA for it. The ACA has nothing whatsoever to do with the phony provider network directories of the health insurance companies that sell plans through the Marketplace.
U.S. Representative Jim Jordan’s ignorance notwithstanding, honestly, how can a U.S. Representative go on record saying that the 80% inaccuracies are not surprising? Has he no sense of right and wrong? Has he no empathy for his constituents and neighboring citizens of Ohio? 80% is a devastating percentage of a provider network to be found inaccurate. It happens to be the worse percentage of any survey yet reported from any state in the United States. Ohioans are hurting, and Rep. Jim Jordan is not helping!
Provider network directories are regulated by the state of Ohio and have existed long before Obamacare. Most other states have accurate physician directories that people who are looking to buy insurance can use to properly assess the health insurance networks and find doctors who are accepting new patients like the list says. Many states have strict laws concerning the accuracy of their lists, and if the lists say they are accepting new patients, they are accepting new patients, and not just 20% of the list, as I have proven in Toledo.Ohio does not have strict provider network directory laws and what little regulation the insurance companies have, is regulated by the Ohio Department of of Insurance, which is just like being regulated by the insurance company itself.
I’m sorry for Findlay losing their major insurer, Medical Mutual and their PPO. We lost them in Toledo too, in fact, all over the state, they are gone. It is a tragedy that Medical Mutual has been allowed to withdraw their long-standing PPO from the individual market, the only insurance they ever offered Ohioans before 2016, and they have been Ohio’s largest insurer since 1934. This is discrimination against a whole class of people, since Medical Mutual still insures Ohio state workers and corporate employees with their PPO, but they no longer offer individuals “real insurance”.Why was there no public forum about this? No fanfare, no articles by Ohio health journalists, no consumer complaints (like mine) made public by the Ohio Department of Insurance while they let Medical Mutual insanely raise their rates throughout 2014, 2015, and 2016, just to eliminate their PPOs in 2017.
My Medical Mutual premium went up 224% in 2014 when it went on the Marketplace, and double-digits in 2015 and 2016. It wasn’t the health mandates that caused the rate hikes, that Mary Taylor tries to make a big deal of, because Medical Mutual already covered all of that. When I complained to the Ohio Department of Insurance about the crazy rate hike of 224% in the first year, they answered my complaint by giving me Medical Mutual’s answer — that the Ohio Department of Insurance approved the rate hike so of course it must be okay. Isn’t it cozy how they’ve got each other’s backs?
I wonder how to take Mary Taylor’s statement in this article that insurance went up 91% on average in four years when mine went up 224% in just one year! If she is saying that premiums going up on average 91% in four years is bad, then how could she have ever approved of Medical Mutual’s rate hike of 224% in just one year? And why wasn’t my complaint properly addressed by her? If it had been, then maybe the individual insurance market wouldn’t be compromised today by Medical Mutual’s discrimination against us by the withdrawal of PPOs sold to self-employed Ohioans. She did all she could to usher in this crime against the individual, all in the name of some diabolical political agenda to deny healthcare to the American people.
In 2016, Ohio had the highest premiums after tax credits.Mary Taylor has assured the failure of the ACA in Ohio in a number of ways. The CMS gave millions of dollars to States to enable “effective rate review.” Our money was used for something else because we never had effective rate review. Effective rate review would have allowed for public forums and open discussions about health insurance prices and problems. Instead, Mary Taylor rubber-stamped any and all rate hikes while keeping the facts far far away from the public. In Ohio, they like us dumb and ignorant.
Mary Taylor allows insurers to maintain provider networks that are on average 80% inaccurate, especially in Toledo where I surveyed them all. What is health insurance if not the provider network? How can insurance regulators allow such extreme dishonesty from our insurers? Why aren’t they looking out for us?
So now with the elimination of Medical Mutual’s PPO, and the total acceptance by Ohio that these new narrow provider networks, that are 80% lies, are just fine, Mary Taylor has the individual market neatly pushed aside as we get slowly snuffed out. We are artists, writers, musicians, inventors, shop owners, entrepreneurs, professionals, and hard-working breadwinners working multiple jobs. And now all of a sudden, we have to choose between having access to great healthcare, like our neighbors who work for the state and corporations, or maybe no healthcare at all, health being something we have to compromise in order to pursue our American Dream?
And what now, does Ohio dream for us? Back to the old, that’s what they want, but at really high prices that the last few years has brought us. Everyone with pre-existing conditions gets thrown under the bus. That would be 25% of us, and the majority would be the older ones my age. Gee thanks, I can’t wait to make it to Medicare age, as the joy of my perky young 60’s instantly taken away.
In Mary Taylor’s glee for dysfunction, the Ohio Department of Insurance laid the perfect backdrop for insurance and hospital hikes and mergers. On their watch, generic drug manufacturers colluded on the price of generic drugs raising prices as much as 8,000%.
And all Mary Taylor can say is, the old laws are in place to fall back on. Regression, regression, regression.
I was interviewed by Patient Daily in regard to the Dec. 4 New York Times article, Insurers’ Flawed Lists Leave Patients Scrambling, specifically about the nitty gritty we face in Ohio with inaccurate provider network directories, the causes and the solutions.
"The quote in the New York Times article was shocking," Penny Gentieu, whose odyssey to find health insurance in 2017 involved contacting 308 physicians in six insurance plans, said in an email to Patient Daily. "That the Ohio Department of Insurance (ODI) said that enforcing the directory accuracy rules is consumer-driven by the public complaints of inaccuracies, one at time."
"Things are so bad in Ohio that the legislature last year allowed the Ohio Department of Insurance to write their own rules about how they handle provider network complaints," Gentieu said. "So-called health-watch people in the know objected, but the ODI wrote in a rule that allowed themselves to make entirely confidential any investigation they had about inaccurate provider networks. Which means that not even the people who complained, let alone the public, ever get to know anything about anything they do or don't do to the insurers in regard to their inaccurate provider network directories. Not only do they not do anything, they completely delete the complaints after two years. It's so crazy!"
"The Ohio legislature is controlled by the very rich and powerful insurance and pharmaceutical lobby industry," she said. "They have meetings, lunches and seminars with the legislators that constituents are not invited to and, consequently, the public's issues are never brought to light because we are way-overshadowed by the big money of health insurance and pharmaceuticals. What the legislators know about health insurance is strictly one-sided."
If state legislators really wanted to do something about this problem, they would make laws with stiff penalties, Gentieu said.
"They would make complaints searchable on the ODI website. They would set up a truly 'effective rate review' annually, with public forums so we have a voice about this extremely terrible problem with health insurance that we face."
"Ohioans have to look under every rock, they have to anticipate any problem, because even though their premiums may have gone up 373 percent -- like mine went up in seven years -- they may only be getting 20 percent of the purported value of the plan."
"Congress should eliminate provider networks, make prices transparent, and take the control out of the hands of the health insurance and pharmaceutical company lobbyists."
"All the doctors should take all the insurance plans. Doctors are either accepting new patients or not. Doctors should not be allowed to lend their names to these plans as if just to beef up the provider network lists to give the insurance plans an illusion of adequacy, when in fact their name listed as accepting new patients when they are not accepting new patients is a total lie. It's false advertising."
"We are small business owners, entrepreneurs, shop owners, artists, writers, musicians and hard-working breadwinners working multiple jobs, " she said. “All of a sudden we have to balance our personal drive and ambitions to our ability to access the best in health care that those working for the government and large corporations are entitled to. It sort of takes down the American Dream, not only for us, but for young people considering their options and people who have a dream but are trapped in their jobs because they provide health insurance."